Healthcare Provider Details

I. General information

NPI: 1932268307
Provider Name (Legal Business Name): MARGARETVILLE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42084 STATE HWY RT 28
MARGARETVILLE NY
12455
US

IV. Provider business mailing address

42084 STATE HWY RT 28
MARGARETVILLE NY
12455
US

V. Phone/Fax

Practice location:
  • Phone: 845-586-2631
  • Fax: 845-586-2539
Mailing address:
  • Phone: 845-586-2631
  • Fax: 845-586-2539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number016327
License Number StateNY

VIII. Authorized Official

Name: RANDALL MOORE
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 845-586-2631